Assessment of Monocyte-to-High Density Cholesterol Ratio and the Delta Neutrophil Index as potential biomarkers in Chronic Periodontitis: A Cross-sectional study.

Assessment of Monocyte-to-High Density Cholesterol Ratio and the Delta Neutrophil Index as potential biomarkers in Chronic Periodontitis patients: A Cross-sectional study.

INTRODUCTION: Chronic periodontitis (CP) is described as an infectious disease resulting in the inflammation of the supporting structures of the teeth with connective tissue attachment loss and alveolar bone loss.

This inflammation of the supporting structures of the periodontium is the mainstay for the pathogenesis of the periodontal disease. The pathogenic bacteria contribute to the spread of the inflammation by its components like lipopolysaccharides which leads to various mechanisms of inflammation. Monocytes which are the largest cells among the leukocytes and contributes to about 2-8% of all the blood cells. They are also the second in line to move to the site of infection. Activated monocytes can produce a number of inflammatory cytokines like tumor necrosis factor-α [TNF-α], Interleukin 1β [IL-1 β] and interleukin-6

As against HDL [High Density Cholesterol] which has potent anti-inflammatory effect which helps in lowering of activated monocytes, neutrophils and prevent the adhesion of the monocytes to the endothelial wall. Monocyte-to-HDL ratio has been now considered as a potent marker or predictor in many inflammatory conditions like atherosclerosis, cardiovascular diseases, chronic kidney diseases, metabolic syndrome, etc. The fraction of immature granulocytes obtained by subtraction of mature polymorphonuclear leucocytes is the Delta Neutrophil Index. It reflects as a potential blood biomarker as it gives the number of immature neutrophils.

Therefore, the aim of this study is to assess the Monocyte-to-High Density Cholesterol Ratio and the Delta Neutrophil Index as potential biomarkers in Chronic Periodontitis patients.

**METHOD OF SELECTION-**The patients satisfying inclusion criteria will be allotted and divided into groups as follows-

Group 1- Clinically Healthy Gingiva

Group 2-Moderate Periodontitis

Group 3- Severe Periodontitis

**METHOD OF DATA COLLECTION:**At the first visit, all patients will receive a complete dental examination

The nature and purpose of the study will be explained to the patient and informed consent will be obtained

The following clinical parameters will be included;

Gingival Index {GI}

Probing Pocket Depth {PD}

Clinical Attachment Loss{CAL} Venous blood will be collected with the help of 24-gauge needle of 5ml syringe Blood samples will be sent for biochemical analysis for Monocyte, Immature Granulocytes, Neutrophil, Eosinophil count and High-Density Cholesterol levels.

Delta neutrophil index will be calculated as the neutrophil subfraction and the eosinophil subfraction - the PMN subfraction